• Journal of Korean Neurosurgical Society
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• 제30권2호
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• pp.211-216
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• 2001

Hemorrhage due to capillary telangiectasia is rare. We report a case of capillary telangiectasia presenting with repeated cerebellar hemorrhage in a 38-year-old male. To our knowledge this is the first case of repeated cerebellar hemorrhage from the capillary telangiectasia. At the first operation, we removed hematoma only, but rebleeding occurred repeatedly in the same area. Finally, we evacuated the recurrent hematoma and vascular mass of capillary telangiectasia at the second operation under surgical microscope. Based on the findings of this case and a review of the literature, we conclude that capillary telangiectasia can be the cause of the massive repeated hemorrhage.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.300-302
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• 2005

The authors report a case of hyperacute, massive hemorrhage in the left basal ganglia with severe midline shift that was treated successfully by the ultrasound-monitored free hand aspiration technique. Every effort was made to shorten time until removal of considerable amount of the hematoma and minimize duration of cerebral herniation, avoiding additional irreversible neurological deficit. A burr hole aspiration technique was preferred to standard craniotomy procedure, and any time-consuming procedures such as stereotactic frame application were abandoned. A burr hole was localized on the basis of computed tomography images simply and quickly with a ruler, and safety of the aspiration procedure was augmented by real-time ultrasound monitoring. Such minimally invasive technique relieved cerebral herniation successfully while avoiding time consumption and the morbidity of major craniotomy procedure. Early resuscitation of the patient with cerebral herniation in this case resulted in excellent recovery of the patient's neurological deficit. The patient's mentality started to improve rapidly and was clear six months after the surgery.

• Journal of Chest Surgery
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• 제22권5호
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• pp.839-844
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• 1989

There appears to be significant problems remained in the treatment of tuberculous empyema with BPF in spite of several surgical methods: decortication, thoracoplasty, and pleuropneumonectomy. We presented one case of tuberculous empyema with BPF. The patient was 42-year-old male and his chief complaint was hemoptysis. In past history, he was treated with left closed thoracostomy and antituberculous medication for two months, 16 years ago. Chest X-ray, tomogram and C. T, revealed a huge mass with central necrosis in the lower 2/3 of left thoracic cavity and shifting of the mediastinal structure to the right. Needle aspiration cytology was undifferentiated large cell carcinoma. Left thoracotomy was made under the impression of lung cancer and pleuropneumonectomy was done. Operative findings; thick walled empyema sac filled with hematoma and BPF, the mediastinum was fixated due to fibrosis and calcification of the pleura and the mediastinum. Postoperative biopsy was consistent with tuberculosis. In the postoperative course, there was massive hemorrhage and so reoperation was done. But there was no active bleeding focuses in the thoracic cavity at the time of reoperation. Massive transfusion, coagulant therapy and intermittent clamping and declamping of the chest tube were carried out. Especially, serum calcium level was chronically decreased and so large amount of calcium gluconate was infused for the calcium level to be normal. Total transfused blood; whole blood was 33 pints, packed cell was 63 pints and fresh frozen plasma was 70 pints. At the postoperative[reop] 45th day, intrathoracic hemorrhage was stopped and the chest tube was removed. In conclusion, this suggest that uncontrollable bleeding after pleuropneumonectomy of the tuberculous empyema with BPF could be treated without reoperation in case of the mediastinal fixation due to fibrosis and calcification of the pleura and the mediastinum.

• Journal of Chest Surgery
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• 제52권3호
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• pp.186-188
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• 2019

We report an unusual case of delayed bleeding after open surgical repair of a thoracoabdominal aortic aneurysm. A 79-year-old man developed a massive retroperitoneal hematoma 49 days after Crawford type III thoracoabdominal aorta replacement. During emergency surgery, a tear was found in the prosthetic vascular graft caused by a sharp bony spur arising from the second lumbar vertebral body. This rare, but potentially lethal, complication indicates that attention should be paid to sharp bony structures during open repair of the descending aorta.

• Tuberculosis and Respiratory Diseases
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• 제65권3호
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• pp.216-221
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• 2008

저자들은 대량 객혈로 발현한 흉곽 내 만성 팽창성 혈종 1예를 보고한다. 이 증례는 이전의 증례와 달리 결핵성늑막염이나 흉부 수술, 외상의 과거력 없이 자연 발생한 증례라는 점에서 의의가 있다. 또한 무증상, 호흡곤란 등으로 발현했던 대부분의 증례와는 달리 드물게 대량객혈로 발현하였으며, 이러한 대량객혈이 기관지흉막루를 동반하여 발생하여 기관지동맥 색전술과 수술로 치료되었다는 점에서 특징적이다. 증례보고와 함께 문헌고찰을 통해 과거 보고된 흉곽 내 만성 팽창성 혈종의 임상양상에 대해 표로 정리하였다.

• Journal of Chest Surgery
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• 제12권4호
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• pp.418-423
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• 1979

Chest injuries due to blunt trauma often result in severe derangements that lead to death. And we have to diagnose and treat the patients who have blunt chest trauma immediately and appropriately. A clinical analysis was made on 324 cases of chest injury due to blunt trauma experienced at department of Thoracic and Cardiovascular Surgery, College of Medicine, Kyung Hee University during 8-year period from 1972 to 1979. Of 324 patients of blunt chest injuries, there were 189 cases of rib fracture, 121 of hemothorax or/and pneumothorax, 108 of soft tissue injury of the chest wall only, 41 of lung contusion, 24 of flail chest, 13 of scapular fracture, 7 of diaphragmatic rupture and others. The majority of blunt chest injury patients were traffic accident victims and falls accounted for the next largest group of accidents. Chest injuries were frequently encountered in the age group between 3rd decade and 4th decade [60%] and 238 patients were male comparing to 86 of female [Male: Female = 3:1 ]. In the patients who have the more number of fractured ribs, the more incidence of intrathoracic injury and intraabdominal organ damage were found. The principal associated injuries were head injury on 58 cases, long bone fractures on 37, skull fractures on 12, pelvic fractures on 10, renal injuries on 6 and intraabdominal organ injuries on 5 patients. The principle of early treatment of chest injury due to blunt trauma were rapid reexpansion of the lung by closed thoracotomy which was indicated on 96 cases, but open thoractomy was necessary on 14 cases because massive bleeding, intrapleural hematoma and/or fibrothorax, or diaphragmatic laceration-On 15 cases who were young and have multiple rib fracture with severe dislocation delayed elective open reduction of the fractured ribs with wire was done on the purpose of preserving normal active life. The over all mortality was 2.8% [9 of 324 cases] due to head injury on 3 cases, massive bleeding on 2,wet lung syndrome, acute renal failure on 1 and septicemia on 1 patient.

• Journal of Korean Neurosurgical Society
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• 제65권5호
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• pp.652-664
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• 2022

The Kernohan-Woltman notch phenomenon (KWNP) refers to an intracranial lesion causing massive side-to-side mass effect which leads to compression of the contralateral cerebral peduncle against the free edge of the cerebellar tentorium. Diagnosis is based on "paradoxical" motor deficit ipsilateral to the lesion associated with radiologic evidence of damage to the contralateral cerebral peduncle. To date, there is scarce evidence regarding KWNP associated neuroimaging patterns and motor function prognostic factors. A systematic review was conducted on Medline database from inception to July 2021 looking for English-language articles concerning KWNP, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The research yielded 45 articles for a total of 51 patients. The mean age was 40.7 years-old and the male/female sex ratio was 2/1. 63% of the patients (32/51) suffered from head trauma with a majority of acute subdural hematomas (57%, 29/51). 57% (29/51) of the patients were in the coma upon admission and 47% (24/51) presented pupil anomalies. KWNP presented the neuroimaging features of compression ischemic stroke located in the contralateral cerebral peduncle, with edema in the surrounding structures and sometimes compression stroke of the cerebral arteries passing nearby. 45% of the patients (23/51) presented a good motor functional outcome; nevertheless, no predisposing factor was identified. A Glasgow coma scale (GCS) of more than 3 showed a trend (p=0.1065) toward a better motor functional outcome. The KWNP is a regional compression syndrome oftentimes caused by sudden and massive uncal herniation and leading to contralateral cerebral peduncle ischemia. Even though patients suffering from KWNP usually present a good overall recovery, patients with a GCS of 3 may present a worse motor functional outcome. In order to better understand this syndrome, future studies will have to focus on more personalized criteria such as individual variation of tentorial notch width.

• Journal of Trauma and Injury
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• 제24권2호
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• pp.164-167
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• 2011

Trauma is an important risk factor for a pulmonary thromboembolism, and anticoagulation is essential to prevent deep vein thrombosis (DVT) in patients with trauma. Low-molecular-weight heparin (LMWH) is excreted in the kidney; therefore, using LMWH in patients with renal insufficiency may increase the risk of bleeding complication. The following case describes a 55-year-old traffic accident victim who had massive bleeding and underwent a laparotomy for bleeding control. The patient had acute renal failure, and enoxaparin was administered for the prophylaxis of DVT. Although the patient suffered from serious complications such as pericardial hematoma, the patient recovered without sequellae and was discharged at day 84.

• 대한골관절종양학회지
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• 제12권1호
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• pp.89-94
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• 2006

신경초종이 오래되어서 퇴행성 변화를 일으키면 이를 퇴행성 신경초종이라고 명칭하며, 드물게 보고되고 있다. 혈관주변의 초자화, 출혈, 석회화, 낭성 괴사, Antoni A 구역의 축소, 핵의 변형 등의 퇴행성 변화가 나타날 수 있으며, 이러한 퇴행성 변화로 인해 육종 등으로 잘못 진단되기 쉽다. 본원에서는 75세 남자 환자의 하퇴부에서 광범위한 출혈과 혈종, 낭성 변화, 석회화, Antoni A 구역의 축소 등의 퇴행성 변화가 진행된 퇴행성 신경초종을 경험하였기에 문헌적 고찰과 함께 이를 보고하는 바이다.

• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제8권2호
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• pp.275-278
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• 2005

소아에서 급성 췌장염은 드문 것으로 되어 있고 췌장염의 가장 흔한 원인은 둔상인 것으로 알려져 있다. 저자들은 복통은 호소하지 않으면서 심한 복부 팽만만을 주소로 내원하여 방사선학 검사 및 복수 천자 후 급성 췌장염으로 진단한 후 수술적 치료로 호전된 환아를 경험하였다.